Healthcare Provider Details

I. General information

NPI: 1750803334
Provider Name (Legal Business Name): JOSE M ACEVEDO RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 140 KM 38.8, BARRIO MAMEYES
UTUADO PR
00641
US

IV. Provider business mailing address

3623 AV MILITAR PMB 427
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 939-276-8359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number21362
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21362
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: